- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,434.37 / $5,548.51 / $9,770.95
| Facility | | $2,434.37 | $5,548.51 | $9,770.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,849.50 / $2,093.78 / $2,966.19
| Professional | | $1,849.50 | $2,093.78 | $2,966.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.00 / $200.00 / $2,680.03
| Professional | | $200.00 | $200.00 | $2,680.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,268.26 / $4,899.43 / $12,188.84
| Facility | | $2,268.26 | $4,899.43 | $12,188.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,859.33 / $16,820.02 / $16,820.02
| Professional | | $3,859.33 | $16,820.02 | $16,820.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $4,536.52 / $7,851.67
| Facility | | $319.00 | $4,536.52 | $7,851.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,442.73 / $4,571.42 / $7,572.50
| Professional | | $2,442.73 | $4,571.42 | $7,572.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,966.19 / $3,446.48 / $6,327.72
| Professional | | $2,966.19 | $3,446.48 | $6,327.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $4,899.43 / $12,562.35
| Facility | | $597.00 | $4,899.43 | $12,562.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,268.26 / $3,803.70 / $8,026.15
| Professional | | $2,268.26 | $3,803.70 | $8,026.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,465.64 / $2,093.78 / $5,478.20
| Professional | | $1,465.64 | $2,093.78 | $5,478.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,489.63 / $4,012.99 / $4,012.99
| Facility | | $3,489.63 | $4,012.99 | $4,012.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,966.19 / $3,489.63 / $4,194.24
| Professional | | $2,966.19 | $3,489.63 | $4,194.24 |